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AINES Tratamiento Preventivo de Migraña Episódica
AINES Tratamiento Preventivo de Migraña Episódica
AINES Tratamiento Preventivo de Migraña Episódica
GLOSSARY
AAN ⫽ American Academy of Neurology; AE ⫽ adverse effect; CI ⫽ confidence interval; HBO ⫽ hyperbaric oxygen; NSAID ⫽
nonsteroidal anti-inflammatory drug; OR ⫽ odds ratio; RR ⫽ relative risk.
Epidemiologic studies suggest approximately 38% reduced number of migraine days, or reduced at-
See page 1337 of migraineurs need preventive therapy, but only tack severity? This article addresses the efficacy
3%–13% currently use it.1 In 2000, the American and safety of histamines/antihistamines; non-
Academy of Neurology (AAN) published guide- steroidal anti-inflammatory drugs (NSAIDs) and
Supplemental data at
www.neurology.org lines for migraine prevention.2,3 Since then, new analgesics; and several herbal, vitamin, and min-
clinical studies have been published on the efficacy eral preparations, whereas a companion article ad-
Supplemental Data
and safety of migraine preventive therapies. This dresses standard pharmacologic treatments for
guideline seeks to assess this new evidence to an- migraine prevention.4
swer the following clinical question: For patients
with migraine, which anti-inflammatory or com- DESCRIPTION OF THE ANALYTIC PROCESS
plementary treatments are effective for prevention, The AAN and the American Headache Society par-
as measured by reduced migraine attack frequency, ticipated in the development process. An author
Podcast
From the Armstrong Atlantic State University (S.H.), Savannah, GA; Thomas Jefferson University (S.D.S.), Jefferson Headache Center, Philadelphia,
PA; Comprehensive Headache Center (F.F.), Baylor University Headache Medicine Center, Dallas, TX; Mayo Clinic (D.D.), Scottsdale, AZ; New
York University School of Medicine (C.A.), Albany; and Elmendorf Air Force Base (E.A.), AK.
CME Appendices e-1– e-5 and tables e-1 and e-2 are available on the Neurology威 Web site at www.neurology.org.
Approved by the Quality Standards Subcommittee on February 19, 2011; by the Practice Committee on June 19, 2011; by the AHS Board of
Directors on March 29, 2012; and by the AAN Board of Directors on November 7, 2011.
Study funding: This guideline was developed with financial support from the American Academy of Neurology and the American Headache Society.
None of the authors received reimbursement, honoraria, or stipends for their participation in the development of this guideline.
Go to Neurology.org for full disclosures. Disclosures deemed relevant by the authors, if any, are provided at the end of this article.
Level A: Medications Level B: Medications Level C: Medications Level U: Inadequate Other: Medications that
with established are probably are possibly or conflicting data are established as
efficacy (>2 Class I effective (1 Class I effective (1 Class II to support or refute possibly or probably
trials) or 2 Class II studies) study) medication use ineffective
Magnesium Cyproheptadine
MIG-99 (feverfew)
Riboflavin
Histamines
Histamine SC
panel of headache and methodologic experts was as- relating to NSAIDs and complementary treatments;
sembled to review the evidence. they are reviewed herein. Clinical studies reviewed
Computerized searches of the MEDLINE, Psyc- were limited to those assessing efficacy of NSAIDs
INFO, and CINAHL databases identified new and complementary treatments for prevention of ep-
studies. The search strategy used the MeSH term isodic migraine in adults (e.g., ⬍15 days/month).
“headache” (exploded) and a published search strat- Studies were excluded if they assessed the efficacy of
egy for identifying randomized controlled trials in therapeutic agents for prevention or treatment of
adults that were published in English between June chronic migraine, intractable migraine, tension-type
1999 and May 2007. Additional MEDLINE headache, or headache in adolescents or children.
searches revealed studies published through May Also excluded were studies that assessed acute mi-
2009, which were reviewed and are included as sup- graine treatment, migraine aura treatment or preven-
plemental articles. tion, or nonpharmacologic treatments. Studies using
Studies of NSAIDs and complementary treat-
quality of life measures, disability assessment, or
ments available in the United States were included in
nonstandardized outcomes as primary efficacy end-
the analysis if they randomized patients with mi-
points were not included. NSAIDs and complemen-
graine to the agent under study or a comparator
tary treatments not commonly or readily available in
treatment (including placebo) and utilized masked
the United States are not reviewed in this guideline.
(blinded) outcome assessment. At least 2 panelists
Since the 2000 guideline publication, the AAN
independently reviewed each selected study and rated
revised its evidence classification criteria to include
it using the AAN therapeutic classification of evi-
study completion rates. Studies whose completion
dence scheme (appendix e-3 on the Neurology® Web
site at www.neurology.org). Differences in ratings rates are below 80% were downgraded.
were resolved by author panel discussion. We found no additional Class I or Class II studies
published since the original guideline for fenoprofen,
ANALYSIS OF EVIDENCE The original search ibuprofen, ketoprofen, naproxen, naproxen sodium,
identified 179 articles and included pharmacologic or indomethacin. Recommendations regarding these
and complementary treatments and NSAIDs. The treatments are based on the evidence reviewed in the
supplemental search from 2007 to 2009 yielded an original guideline (denoted in table 1).
additional 105 articles. Of the total 284 articles, 15 Following is a summary of Class I and Class II
were classified as Class I or Class II and identified as evidence for the efficacy of NSAIDs and comple-
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since
1951, it is now a weekly with 48 issues per year. Copyright Copyright © 2012 by AAN Enterprises, Inc.. All
rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.
Updated Information & including high resolution figures, can be found at:
Services http://www.neurology.org/content/78/17/1346.full.html
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since
1951, it is now a weekly with 48 issues per year. Copyright Copyright © 2012 by AAN Enterprises, Inc.. All
rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.